Total colonoscopy in children.

the case of a bruise on the side of the forehead, cheeks, or chin, even in at-risk infants. It is not uncommon for the truth (that they are really finger bruises) to be admitted after a Care Order has been obtained after more severe injury. In older children, by contrast, bruises, even those resembling finger tip bruises, are common and can be accepted as accidental, as shown by Keen' in his careful study of 3-and 4-year-old children. In view of our observations, it was decided to assess the incidence of facial and other bruises in a random sample of babies under age 1 year. Altogether 620 examinations ofnaked babies who were attending either a local authority health clinic, or a hospital follow-up clinic were made. Bruises were seen on 6 babies only. Case 1: Age 10 months. Already walking, showed 3 typical small (less than 15 mm) toddler shin bruises on each leg. Case 2: Age 11 months. Already walking, showed one typical small toddler shin bruise and a swollen 15 mm central forehead bruise. Case 3: Age 10 months. Actively crawling, showed a 5 mm bruise on the outer aspect of the right arm and a small scratch on the outside of the right thigh. Case 4: Age 10 months. A crawling baby who was able to climb upstairs, showed a 10 x 10 mm bruise on the point of the chin, caused by slipping against the coffee table. Case 5: Age 9 months. An active, crawling, climbing baby showed a tiny central forehead bruise, caused by a fall from a toy tractor. Case 6: Age 3 months. Had a 5 x 10 mm bruise under the right eye, due to falling on the telephone. It is interesting that in our study the bruises, with one exception, were seen in babies of at least 9 months, who were already actively crawling or walking. The facial bruises in these children were on the central forehead, or point of the chin and showed, or had shown, swelling due to 'hard, contact' injury. They were quite dissimilar to the finger tip and thumb bruises seen in child abuse and so clearly described by Hall.2 The exception, Case 6, caused us anxiety, especially as an older sibling had also had worrying incidents. It was considered that the problem was due to an unacceptable level of carelessness and the situation was closely monitored by …